The Focus-Based Integrated Model (FBIM) tailors interventions based on a functional assessment of clients' needs, integrating psychotherapy with pharmacological or rehabilitative support when necessary and emphasizing a strong Working Alliance (WA). This study evaluated therapeutic progress in clients treated with FBIM at four time points: baseline (T0), 3 months (T1), 12 months (T2), and follow-ups at 3 months post-therapy (T3). From April 2022 to July 2024, this longitudinal study was conducted at a community-based psychotherapy centre in Italy, enrolling 154 participants (Mage = 32.8 years; 54.3% female) who completed baseline assessments, with sociodemographic and clinical data collected on symptom severity, WA, and client motivation. Symptom severity declined significantly from T0 to T2. Within the integrated approach employed, that combined psychodynamic and Cognitive Behavioural Therapy (CBT) components, CBT showed stronger Task subscale scores at T2. Resistance to change impacted WA at T1 but decreased by T2. Contextual differences in WA at T1 diminished over time. Client motivation had no effect on WA. Structured approaches like CBT foster early collaboration, while changes in the WA over time reflect the therapist's capacity to adapt to client needs and therapeutic challenges.

This study explored whether the strength of parent-home visitor working alliances might alter the benefits of Recipe 4 Success, a highly structured food-based curriculum designed to promote parents' sensitive scaffolding, responsive food parenting practices, toddlers' self-regulation, and healthy eating habits. This study included 242 parents and their toddlers residing in the United States, most of whom were living in poverty (37% white, 25% Black, 19% Latiné, 17% Multiracial, and 2% Asian; median income=$1555 per month). Families were randomly assigned to Recipe 4 Success or usual practice home visits within home visitor caseload. Home visitors tended to rate their working alliance as very strong versus less strong. Within-group regression equations revealed that, among families with a less strong working alliance, Recipe 4 Success was more effective than usual practice home visits in improving parents' sensitive scaffolding, responsive food parenting practices, and toddlers' self-regulation. In contrast, among families who had a strong working alliance, Recipe 4 Success was more effective than usual practice home visits in changing toddlers' healthy eating habits, including reducing body mass index for toddlers with overweight/obesity. These findings highlight how families with varying strengths of working alliances may benefit differently from highly structured evidence-based curricula.

Teacher-student relationships (TSRs) are critical for student development, yet little is known about the role that malleable child-level skills and experiences play in shaping TSR quality among students with disabilities experiencing behavioral difficulties. This study examines how student experiences (e.g., classroom working alliance) and skills (i.e., social skills, internalizing/externalizing behaviors) relate to TSR quality as perceived by both teachers and students. Participants included 185 students with disabilities and 76 special education teachers across 50 schools. Multi-informant assessments and regression analyses revealed that working alliance, specific social skills, and externalizing problem behaviors were uniquely associated with both positive (e.g., trust, closeness) and negative (e.g., conflict, alienation) TSR dimensions. Importantly, working alliance emerged as a consistent predictor across both rater perspectives, while discrepancies between teacher and student perceptions highlighted the importance of using multi-informant approaches. Findings underscore the potential of interventions targeting alliance-building and social-emotional skills to enhance TSRs for students with elevated behavioral needs. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Implementing gestational weight gain guidelines in midwifery practice: A qualitative study using Normalisation Process Theory.

Grief is a stressful experience following the death of a loved one that differs among cultures. For decades, researchers have explored the connections between grief and culture, as well as their contextual influences. Our research question is: how do ethnoracial minoritized caregivers in the United States experiencing grief articulate their bereavement experiences and how might their experiences inform improved approaches to therapeutic relationships (e.g., fostering trust) when healthcare providers are working with ethnorocial minoritized clients? To address this question, we conducted a qualitative descriptive study to explore experiences of traumatic loss in the United States. Interviews were conducted until meaning saturation was reached. Nineteen ethnoracial minoritized caregivers completed the Prolonged Grief-13-Revised scale and the Multidimensional Existential Meaning Scale to assess their grief and meaning-making. Semi-structured interviews were conducted from April to July 2024. Participants were predominantly male (63.2%), married (73.68%), and had bachelor's degrees or higher (63.16%). Analysis revealed themes of different grief experiences and their associated contextual and emotional antecedents. Together, these themes illustrate ways in which bereaved caregivers face challenges with self-care, and this, alongside specific expressions of family grief, results in functional impairments. The study highlights the complexities of relationships, stigma, and resistance to grief therapy and the potential benefits of focusing on family dynamics to improve the treatment of prolonged grief disorder at an individual level.

Suicide attempts can lead to life-threatening conditions that require intensive care. In such situations, patients often experience existential fear when cared for in highly technological and unfamiliar environments such as the intensive care unit. The circumstances surrounding the suicide attempt, together with their critical condition, may further influence their ability to cope and shape their experience of care. Understanding these experiences is important to ensure that the therapeutic relationship supports the recovery process. Interprofessional collaboration and communication are essential for coordinated, recovery-oriented care. To map the existing evidence on how patients, family members and healthcare personnel experience care in intensive care units following a suicide attempt, to identify key themes, knowledge gaps and implications for clinical practice and future research. This scoping review was conducted using the Arksey and O'Malley methodology and the PRISMA-ScR list. Six databases were systematically searched using predefined keywords. All English-language studies addressing the review aim were included. The search yielded 1107 articles. After screening, 13 were assessed in full, and five met the inclusion criteria. These studies, published between 1985 and 2011, comprised four surveys and one qualitative interview study. Findings indicate that patients felt misunderstood, families lacked information and support, and personnel experienced emotional strain. Attitudes varied widely, and healthcare personnel expressed a need for further education and reflective practice in suicide care. Only five relevant studies were identified, all published between 1985 and 2011, with just one including patient or family perspectives. This limited and dated research highlights a clear gap in research on intensive care following suicide attempts and precludes firm conclusions about care experience. With these constraints, the findings tentatively suggest the importance of compassionate, holistic and collaborative approaches to care, as well as the potential value of personnel's support and training and policies that attend to the mental health needs of suicidal patients and their families. The findings may suggest the potential relevance of a holistic approach to caring for patients after a suicide in ICU practice, where physical, psychological, social and emotional aspects of care are considered in supporting recovery and well-being.

Emotional availability is an essential yet underexplored concept in nursing, critical for addressing patients’ holistic needs amid the increasing complexity of health systems. The absence of a clear conceptualization may limit nurses’ emotional engagement, their response to health disparities, and the delivery of person-centered care, ultimately affecting patient outcomes and increasing the risk of nurse burnout. To analyze and clarify the concept of emotional availability within the context of professional nursing practice. A concept analysis was conducted using Walker and Avant’s eight-step model. Four defining attributes of emotional availability emerged: self-awareness, empathy, emotional regulation, and effective communication. The analysis also identified antecedents, consequences, and empirical referents, and presented them using models: borderline, related, contrary, illegitimate, and invented cases. Findings suggest that emotional availability enhances patient satisfaction, self-efficacy, compliance, and health outcomes while supporting nurses’ emotional resilience. Emotional availability is a foundational nursing competency that fosters therapeutic relationships, improves patient care experiences, and enhances nurse well-being. A clearer understanding of emotional availability can inform nursing education, practice, and policy, thereby strengthening holistic care delivery and ultimately improving patient outcomes.

Oncology nurse navigators play a critical role in addressing patients' physical, emotional, social, and spiritual needs. However, gaps in existing training programmes often limit the effective integration of holistic care principles and therapeutic relationship skills into clinical practice. Online education offers potential flexibility and scalability, yet evidence regarding its effectiveness for developing these competencies remains limited. This study employed a quasi-experimental design comprising two sequential phases of online training aimed at bridging theoretical foundations and practical application in oncology nursing navigation. Healthcare professionals across Taiwan participated in Phase One, which consisted of online dialogic seminars focusing on foundational concepts of holistic care. Phase Two involved situation-based simulations and structured reflective discussions to strengthen applied skills. Holistic care competence and therapeutic relationship skills were assessed at baseline (T1), mid-training (T2), and post-training (T3) using validated self-report instruments. Data were analysed using paired t-tests and repeated measures ANOVA. A total of 337 healthcare professionals completed Phase One, of whom 34 oncology nursing professionals met eligibility criteria and participated in Phase Two. Statistically significant improvements were observed in holistic care competence, with paired t-tests indicating significant gains from T1 to T2 across all dimensions (t = - 9.65 to - 13.00, all p < .001). In Phase Two (n = 34), repeated-measures ANOVA confirmed significant improvement in holistic care competence across T1, T2, and T3 (F(1.50, 49.47) = 14.83, p < .001, η2p = .310, Greenhouse-Geisser corrected). Therapeutic relationship skills also improved significantly (F(1.35, 44.56) = 12.18, p < .001, η2p = .270), with the majority of improvement occurring from T1 to T2 (d = 0.59, p = .002). Effect sizes from T1 to T3 ranged from medium to large across holistic care dimensions (Cohen's d = 0.81-1.07). The findings suggest that an interactive online training programme incorporating scenario-based learning and reflective discussion was associated with enhanced holistic care competence and therapeutic relationship skills among oncology nursing professionals. Baseline therapeutic relationship skills predicted learning gains across all holistic care dimensions, indicating that relational competence may function as a foundational infrastructure for holistic care learning; accordingly, positioning relational skills training as an early component of oncology nursing curricula may optimise learning outcomes across all dimensions of holistic care. While the results are context-specific, this approach demonstrates potential as a feasible and scalable model for advancing professional education in oncology and palliative care settings.

This study examined the longitudinal associations and temporal precedence between therapeutic presence and working alliance in psychotherapy. The data set comprised 14,498 sessions conducted by 208 master's-level trainee therapists with 1,587 clients in China. After each session, both therapists and clients completed standardized measures of therapeutic presence and working alliance. Results from random-intercept cross-lagged panel modeling indicated that, at the between-person level, therapist-client dyads that reported higher average therapeutic presence also tended to report higher average working alliance based on both client and therapist ratings. At the within-person, between-session level, a unidirectional temporal pathway was identified: From both client and therapist perspectives, higher therapeutic presence in a session consistently predicted higher subsequent working alliance across the course of treatment, whereas working alliance did not significantly predict subsequent therapeutic presence. These findings underscore the pivotal role of therapeutic presence as a precursor to a strong working alliance, highlighting its importance in fostering effective therapeutic relationships and positive treatment processes. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Limited research has examined cultural processes for addressing spirituality and/or religion (S/R) in psychotherapy. In total, 143 religious and/or spiritually oriented psychotherapy clients who preferred a spiritually integrated approach completed outcome measures (well-being, depression, anxiety, spiritual struggles) in the first month of treatment and 3 months later. Participants also completed assessments of treatment dropout and satisfaction, along with validated measures of their clinician's cultural humility for their S/R, clinicians' cultural missed opportunities for addressing their S/R, and their own concealment of S/R, at follow-up. Cultural processes related to S/R were associated with treatment outcomes, dropout, and satisfaction in anticipated directions in bivariate analyses. Findings for cultural humility fell to nonsignificant in the presence of baseline outcomes, working alliance, and other cultural processes. In contrast, adverse cultural processes emerged as robust correlates of indices for a successful course of psychotherapy in multivariate analyses. Specifically, clients' concealment of their spiritual and/or religious identities was uniquely associated with poorer outcomes (lower well-being, greater anxiety symptoms and spiritual struggles) and clinicians' missed opportunities to discuss S/R in the treatment process were uniquely linked with lower satisfaction. Cultural processes did not predict the likelihood of dropout beyond the participants' working alliance ratings. Overall, this pattern indicates the utility of attending to cultural processes associated with addressing S/R in psychotherapy with religious and/or spiritually oriented clients while also highlighting a need for rigorous research that might advance clinical training and practice along these lines. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Objective Evidence of the association between previous suicide attempts and psychotherapy outcome is inconclusive because of a lack of transdiagnostic investigations and diverging methodological approaches to treatment success. The present work aimed to address these research gaps. Method We used routine patient data (N = 706; N = 118 with a lifetime history of suicide attempts) to investigate the relevance of suicide attempts for outcome using validated instruments (Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Screener (GAD-7)), testing the association in different ways: symptom reductions, achievement of subclinical symptom levels, reliable and clinically significant change (RCI, RCSI), subjective evaluations of the therapeutic relationship (Helping Alliance Questionnaire (HAQ)), and regression models of symptoms at discharge adjusted for baseline severity and personality functioning. Results Although patients with a history of suicide attempts exhibited greater baseline symptom severity, they achieved comparable reductions in depression and anxiety symptoms (in terms of absolute values as well as using the RCI and RCSI). They achieved comparatively greater mean decreases in suicidal ideation but were less likely to be classified as responders on the suicidal ideation item and less likely to report subclinical levels of depression symptoms or the absence of suicidal ideation at discharge. Regression analyses that controlled for baseline symptoms and the level of personality functioning revealed no independent effect of suicide attempts. Treatment satisfaction and perceived success were comparable across groups. Discussion/Conclusion Previous suicide attempts are an important marker of clinical severity. While comparable symptom reductions are achieved, reaching the subclinical symptom range might be harder for individuals struggling with suicidality. These findings emphasize the importance of contextualizing treatment success (methodologically and with respect to the individual case).

BackgroundArtificial intelligence (AI) may offer potential to augment risk assessment and expand personalised treatment in prison psychiatry. In Queensland, prisoners experience high rates of mental illness, and Aboriginal and Torres Strait Islander people are overrepresented, placing additional demands on already overstretched services.PurposeTo explore the potential role of AI in enhancing clinical decision-making, improving risk assessment (including recidivism, self-harm, and violence), and supporting more personalised treatment approaches within prison psychiatry. Research DesignConceptual and ethical discussion of AI applications in correctional mental health, considering clinical, cultural, and systemic implications.Study SampleConceptual discussion focused on prison populations in Queensland, particularly individuals with mental illness and Aboriginal and Torres Strait Islander peoples.Data Collection and/or AnalysisCritical synthesis of emerging AI risk-prediction models and their potential application in correctional psychiatry, alongside analysis of ethical considerations such as bias, transparency, and cultural competence.ResultsAI-based risk-prediction models may help identify emerging risks related to recidivism, self-harm, and violence, supporting earlier intervention and improved resource allocation. However, these models may also reproduce structural biases embedded in underlying data, raising concerns about equity and fairness. ConclusionsAI has potential to support, but not replace, clinical judgement and therapeutic relationships in prison psychiatry. Ethical implementation requires rigorous validation, transparency, and sustained human oversight, with strong emphasis on cultural competence to ensure equitable outcomes.

BackgroundPsychiatric inpatients in China may experience threats to dignity and self-expression within ward environments shaped by stigma, safety concerns, and institutional routines. However, how they navigate these challenges and restore dignity through everyday interactions during hospitalization remains underexplored in psychiatric nursing.AimTo develop a substantive theoretical framework explaining how Chinese psychiatric inpatients experience dignity challenges and navigate pathways toward dignity empowerment and restoration during hospitalization, and what role therapeutic relationships with mental health nurses play in facilitating this process.Research designConstructivist grounded theory following the Charmaz tradition, informed by relational autonomy theory.Participants and research context11 psychiatric inpatients were recruited from the psychiatric ward of a tertiary general hospital in China between March and June 2025, using maximum variation purposive sampling to ensure demographic diversity.Ethical considerationsEthical approval was obtained from the Ethics Committee of Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Reference 2025-2245-01).FindingsThe theoretical model "Finding Voice in Vulnerability" suggests that psychiatric inpatients may navigate dignity challenges through four interconnected relational processes: Cognitive Liberation and Conceptual Reconstruction, Relational Dignity Empowerment, Relational Reconstruction of Valued Identity, and Participatory Treatment Negotiation. The model further suggests that vulnerability may become a relational resource through dignity-affirming interactions that support autonomy and participation in treatment decisions.ConclusionsDignity empowerment may emerge through relational recognition rather than individual autonomy, suggesting a potential reorientation toward relationally informed psychiatric care. The findings suggest that everyday nursing interactions may be important contexts for empowerment, with implications for relational competency training and future longitudinal research across diverse psychiatric settings.

ABSTRACT Objective Therapeutic relationship is a core element of brief motivational intervention (bMI). Behavioral coding is the gold standard for capturing relational factors, but it is highly time-consuming. We aimed to examine the association between vocal arousal synchrony and the quality of the therapeutic relationship. Method This secondary analysis used 135 audio-recorded alcohol bMIs among French-speaking young adults (18-35 y.) from a randomized controlled trial. bMIs were categorized into higher and lower levels of therapist empathy, collaboration, therapeutic alliance and patient’s perspective. The therapist’s and patient’s mean fundamental frequency of the voice (mean ƒ0) was extracted at 0.25-second intervals. Mean ƒ0 synchrony was computed at session- and minute-levels using Bayesian multilevel multivariate models and compared to higher- vs. lower-rated sessions. Results Higher-therapist empathy and higher-therapeutic alliance sessions showed medium-to-large mean ƒ0 synchrony while lower-rated sessions showed lower nonsignificant synchrony. However, differences in the degree of synchrony between higher- and lower-rated sessions were medium-to-large but nonsignificant. We found no evidence for mean ƒ0 synchrony at the minute-level for both measures, nor at all levels for therapist collaboration and the patient’s perspective. Conclusion While the findings provide partial support for this paralinguistic feature modeling the therapist’s relational skills, further research should examine under which conditions synchrony may predict relational factors.

ABSTRACT Relational depth is a profound moment of connection in the therapeutic relationship and accounts for 10-30% of positive effects of therapy. Although there seems to be a spiritual component to relational depth, no research, to date, has explored the spirituality of the therapist who invites moments of relational depth. The purpose of this conceptual paper is to explore the ways that Ingersoll’s 10 components of spiritual wellness connect with foundations of relational depth. It is postulated that therapists’ spiritual wellness could enhance their capacity to invite moments of relational depth in the therapeutic encounter. A case study and implications are included.

This study examines the experiences of lesbian, gay, bisexual, transgender, and queer/questioning, and related (LGBTQ+) individuals with psychiatric diagnoses regarding self-disclosure by LGBTQ+ social workers in mental health services. Understanding their perspectives and reflections contributes to deeper insight into the recovery process and the specific needs of LGBTQ+ clients. Twenty-nine LGBTQ+ individuals with psychiatric diagnoses receiving psychiatric rehabilitation services in Israel participated in semistructured in-depth interviews. Guided by intersectionality theory, this phenomenological study explores how shared identity shapes therapeutic relationships in mental health care. Findings revealed that therapist self-disclosure functions as a complex relational process. Visibility was experienced as a therapeutic resource that fostered trust, safety, and belonging and accelerated the development of the therapeutic alliance. At the same time, shared identity introduced ethical and relational complexities, including blurred boundaries, confidentiality concerns, and the risk of reducing clients' experiences to a single identity axis. Participants further described how professional stance and boundary negotiation enabled processes of rupture and repair, allowing challenges to be transformed into opportunities for deeper therapeutic engagement. The findings suggest that LGBTQ+ identity disclosure is neither inherently beneficial nor harmful, but depends on context, timing, implementation, and client interpretation. When enacted reflexively and supported by supervision, self-disclosure can enhance therapeutic care, reduce stigma, and promote equity in mental health services. These results underscore the need for structured training and institutional support to guide ethical and affirmative disclosure practices in clinical social work. Supporting LGBTQ+ visibility promotes social justice and inclusivity at the policy level. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Contemporary health care discourse increasingly recognises the need to move beyond purely functional and optimisation-based models of health. Yet prevailing approaches often fragment the human person into biological, psychological, and-when included-spiritual domains, without a coherent anthropological basis capable of integrating them. This article introduces Holostasis as an anthropological framework in which health is understood as personal orientation sustained through change-a stability-in-change proper to personal existence, distinct from equilibrium-based or functional conceptions. Rather than proposing a physiological mechanism or an operative clinical model, Holostasis is articulated at a pre-clinical and epistemological level, offering a conceptual criterion for rethinking health and illness from the unity of the person. Drawing on philosophical anthropology and the philosophy of medicine, the paper distinguishes Holostasis from regulatory notions such as homeostasis and allostasis, as well as from additive holistic and integrative approaches. It develops an account of health as continuity of meaning, orientation toward truth, and relational integrity, including conditions of vulnerability, illness, and functional limitation. By foregrounding the therapeutic relationship and the limits of optimisation paradigms, Holostasis is proposed as an open interpretative contribution to contemporary debates on personhood, health, and person-centred care.

Using discourse analysis to teach communication and relational strategies in nurse education.

The emergence and increasing use of artificial intelligence (AI) in healthcare have paved the way for highly personalized and time-saving approaches in the field of precision medicine. It can be applied to determine a prognosis, diagnosis, and recommended treatment, and may also be used for patient monitoring. As AI applications become more widely available, reliable and easy to use, they are rapidly reshaping the traditional roles of professionals and patients in the therapeutic relationship. On the positive side, professionals may have more time to communicate with patients and provide individualized care, whereas patients may become more empowered and autonomous due to AI-facilitated personalized information and monitoring. On the negative side, AI applications threaten to reduce the role of professionals to a mediating one in clinical decision-making, provide patients with misinformation, and lead to misunderstandings that hinder patients' autonomy. In this narrative review, we examine the main ethical issues related to the AI-induced shift in roles in the therapeutic relationship, within four inter-related themes: the validity of claims that algorithms outperform humans in certain tasks; the ways in which AI saves time for health professionals but also takes time to properly explain and implement; the issues of trust and accountability, especially if AI suggestions lead to patient harm; and what AI's alleged cost-effectiveness means for professionals' employment and remuneration. Across the three roles, we find a common pattern: AI tends to absorb the technical and data-processing parts of clinical work while leaving its relational core to humans. Physicians move toward oversight and interpretation, nurses retain the attentiveness and responsiveness that define care, and patients gain tools for self-management that can widen autonomy or, left unguided, erode it. Whether the overall effect is benign depends less on the technology than on how outperformance is evidenced, how the freed time is used, how trust and accountability are anchored in people, and how cost pressures are managed. The article concludes with some suggestions for prudent use of AI in healthcare, indicating the appropriate measures that can be used to harness the power of AI without damaging the traditional cornerstones of the therapeutic relationship.

Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as "new racism". Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems.